home
RSS
Get Some Sleep: Beware the sleeping pill hangover
June 7th, 2011
04:28 PM ET

Get Some Sleep: Beware the sleeping pill hangover

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Henry was 80 years old and “tired all the time.” His primary care doc had done a thorough work up. I tested for every sleep disorder known to man and god and found no underlying problem with his sleep quality.

At our initial visit, I had expressed my concern that his hypnotic medication, Clonazepam, could be part of the problem, especially because his dose of 2 mg was rather high for a man his age. He had been reluctant to make any changes to a medication that, from his point of view, had worked so well for him over the years. Now, with all other explanations ruled out, he was ready to try to get off it in order to feel less groggy in the morning.

I tapered him slowly and he had no withdrawal symptoms nor any rebound insomnia. He feels more energetic and less sleepy in the daytime and he only occasionally uses a sleeping aid when he has trouble falling asleep.

This is a scenario that is played out every day in my sleep clinic: the medications that we doctors give to help patients sleep end up making them feel tired and groggy the next day.

Clonazepam (Klonopin) is a common culprit. It belongs to a class of drugs called benzodiazepines. They have been used as sleeping agents for decades. They have many other uses including the treatment of anxiety, seizure and muscle spasm.

In general, these drugs can be very useful sleep aids, but must be used cautiously because they will often cause dependence, tolerance, withdrawal and rebound insomnia if used long enough on a nightly basis. Dependence is fairly self-explanatory and means that a person cannot sleep without the drug. Tolerance means that that the dosage has to be repeatedly increased to achieve the same affect. It is not the same as addiction but is often confused with it.

They can also cause withdrawal which means the emergence of a new set of symptoms that were not present before using the medication. Common withdrawal symptoms include agitation, nausea, sweating and palpitations.

The benzodiazepines can cause rebound insomnia. Rebound insomnia means insomnia that is worse than it was before a patient started the drug. Typically, it lasts only one or two nights.

The problem with Clonazepam in particular is that it has a very long half life. Therefore, it takes a long time to clear the system and its hypnotic and sedating effects can last well into the next day. There can be withdrawal if stopped abruptly, but it is less likely to cause rebound insomnia when compared to shorter-acting benzos.

Besides daytime sedation, any of the benzodiazepines can cause amnesia, sleepwalking and sleep eating. There are studies showing increased fall risk in the elderly, but there is also research showing that untreated insomnia increases falls. There is definite concern that these medications can have multiple deleterious effects in the elderly including memory and cognition problems. As with most medications, the doses should be lower when patients are elderly or have liver or kidney impairment.

For insomnia treatment, it is better to use benzodiazepines that have a medium half life such as lorazepam or temazepam. They will usually help someone get to sleep and stay asleep most of the night without too much hangover effect the next morning.

As with most prescription sleep aids, I recommend intermittent use so that tolerance and withdrawal might be avoided.

Medications such as zolpidem (Ambien) are called non-benzodiazepines but that is misleading because they act on the same GABA benzodiazepine receptors in the brain. They just don’t bind to as many subunits as the traditional benzos which has good and bad effects. One bad effect is that drugs like Ambien have no anti-anxiety properties and most people with insomnia have anxiety either that is fueling the insomnia or as a consequence of the insomnia.

Therefore, if someone has chronic, nightly difficulty falling asleep or staying asleep, I recommend CBT-I (cognitive behavioral therapy for insomnia). As I have discussed in previous posts, it is the safest treatment and actually the most effective one in the long term.

Post by:
Filed under: Sleep

soundoff (591 Responses)
  1. alprostadil injection

    alprostadil nasal spray https://alprostadildrugs.com/ alprostadil suppository injection demonstration

    April 3, 2021 at 16:31 | Report abuse | Reply
  2. M106.COM & Google

    I sincerely took delight in reading your web site, you explained some excellent points. I want to bookmark your post. I saved you to delicious and yahoo bookmarks. I will attempt to revisit to your webpage and examine more posts. http://www.piano.m106.com

    http://www.m106.com

    April 5, 2021 at 02:22 | Report abuse | Reply
  3. generic levitra vardenafil 20mg

    vardenafil how to take https://vegavardenafil.com/ vardenafil 20 mg

    April 5, 2021 at 11:50 | Report abuse | Reply
  4. Boomcycle Digital Marketing

    carry on, dont stop.Boomcycle Digital Marketing Offers Tested And Trusted Bay Area SEO Services.

    http://business.times-online.com/times-online/news/read/41137738/Boomcycle_Digital_Marketing_Offers_Tested_And_Trusted_Bay_Area_SEO_Services

    April 7, 2021 at 11:05 | Report abuse | Reply
  5. best Italian Orlando

    Commenting on a blog is an art. Good comments create relations. You're doing great work. Keep it up.

    http://italianrestaurantorlando.dsiblogger.com/30129856/visit-an-italian-restaurant-while-you-are-on-vacation

    April 7, 2021 at 13:06 | Report abuse | Reply
  6. AKepeentill

    pharmacie en ligne andorre zopiclone , pharmacie ouverte quetigny therapies revue , https://www.kisskissbankbank.com/fr/users/metformine-en-ligne-pas-cher# act therapy online resources pharmacie beauvais ouverte le lundi pharmacie hamidi argenteuil Tamoxifene Tamoxifen 20 online Tamoxifene sans ordonnance en ligne, Acheter Tamoxifene 20 pas cher , pharmacie de garde aujourd'hui lapalisse therapie cognitivo-comportementale rive-nord , pharmacie leclerc quevert fresna fa16ee2 pharmacie tordjman argenteuil. pharmacie vrel amiens pharmacie leclerc ibos Pharmacie Neurontin 600 pas cher Pharmacie Neurontin 600 pas cher , pharmacie bailly achat en ligne therapie cognitivo comportementale psychiatre , pharmacie leclerc dommartin les toul. pharmacie de garde nancy, pharmacie lafayette givors pharmacie de garde xonrupt longemer . pharmacie michel annecy , therapie cognitivo comportementale formation pharmacie ouverte toulouse pharmacie en ligne qui livre pharmacie ustaritz .

    April 7, 2021 at 18:41 | Report abuse | Reply
  7. AKepeentill

    therapie de couple waterloo , pharmacie lafayette des quatre pavillons cenon therapie cognitivo comportementale montpellier https://www.gamereactor.pt/blogs/Logiciel/2813/Logiciel+espion+telephone+espionner+un+telephone+a+distance/# , https://www.kisskissbankbank.com/fr/users/modafinil-sans-ordonnance-acheter-modafinil# pharmacie de garde aujourd'hui limoges medicaments sciatique medicaments jambes lourdes Amoxicilline Amoxil 200 online Pharmacie Amoxicilline 200 pas cher , pharmacie de garde aujourd'hui carcassonne pharmacie de garde ajaccio , pharmacie ouverte versailles cagnitiva b984383 act therapy toronto. traitement keratine pharmacie beauvais nelson mandela Pharmacie Furosemide 100 pas cher Pharmacie Furosemide 100 pas cher , pharmacie dumont bourges therapie de couple caen , generique du spasfon comprime. pharmacie amiens delpech, therapie cognitivo-comportementale drummondville pharmacie yutz . pharmacie bourges intermarche , pharmacie horaire pharmacie ouverte sarcelles pharmacie bourges ouverte lundi therapies katy .

    April 8, 2021 at 01:20 | Report abuse | Reply
  8. best italian restaurants in orlando

    Thank you, I've just been looking for information approximately this topic for a long time and yours is the greatest I have discovered so far. But, what in regards to the conclusion? Are you certain concerning the supply?

    http://italianrestaurantorlando.jiliblog.com/57564771/myths-about-italian-restaurants

    April 8, 2021 at 06:03 | Report abuse | Reply
  9. order sildenafil us

    sildenafil generic india https://eunicesildenafilcitrate.com/ sildenafil 100mg price

    April 8, 2021 at 06:14 | Report abuse | Reply
  10. orlando italian restaurants

    A great read. I'll definitely be back.

    http://italianrestaurantorlando.amoblog.com/how-to-pick-italian-restaurants-21081910

    April 8, 2021 at 07:20 | Report abuse | Reply
  11. italian restaurants downtown orlando

    thanks for sharing!

    http://italianrestaurantorlando.blog2learn.com/46382743/healthy-eating-options-available-at-italian-restaurants

    April 8, 2021 at 08:31 | Report abuse | Reply
  12. best italian restaurants in orlando

    Thanks for wonderful information I used to be in search of this info for my mission.

    http://italianrestaurantorlando.blogzag.com/43803718/italian-restaurant-good-service-matters

    April 8, 2021 at 09:13 | Report abuse | Reply
  13. best independent Italian spot

    this is very informative and intersting for those who are interested in blogging field.

    http://italianrestaurantorlando.link4blogs.com/22760543/how-to-find-the-best-italian-food-restaurants

    April 8, 2021 at 12:19 | Report abuse | Reply
  14. Best Window Cleaning Service Near Me Cheesman Park, Denver, CO

    Your writing style has been surprised me. Thank you, quite great article.

    https://www.2findlocal.com/b/13263720/signature-window-washing-denver-co

    April 8, 2021 at 13:04 | Report abuse | Reply
  15. Budowa Pianina

    Fantastic job here. I seriously enjoyed what you had to say. Keep heading because you absolutely bring a new voice to this subject. Not many people would say what youve said and still make it interesting. Properly, at least Im interested. Cant wait to see much more of this from you.

    http://www.pianino.xmc.pl

    April 8, 2021 at 21:34 | Report abuse | Reply
  16. Window Washing Service Curtis Park, Denver, CO

    Your writing style has been surprised me. Thank you, quite great article.

    http://580washingtonave.com/content-marketing-in-sam-ramon-ca/

    April 9, 2021 at 06:38 | Report abuse | Reply
  17. Best Window Washing Service Near Me Athmar Park, Denver, CO

    This blog is great check it out

    http://goldencirclewebdesign.com/content-marketing-in-sam-ramon-ca/

    April 9, 2021 at 07:10 | Report abuse | Reply
  18. Best Window Cleaning Service Near Me Lincoln Park, Denver, CO

    very interesting , good job and thanks for sharing such a good blog.

    https://www.bizwiki.com/window-cleaning/17209499/signature-window-washing.htm

    April 9, 2021 at 08:03 | Report abuse | Reply
  19. Best Window Washing Service Near Me West Colfax, Denver, CO

    This is a very interesting article. Please, share more like this!

    https://www.chamberofcommerce.com/united-states/colorado/denver/abrasive-products-manufacturers/2011452241-signature-window-washing

    April 9, 2021 at 08:33 | Report abuse | Reply
  20. Window Washing Service Barnum West, Denver, CO

    A great read. I'll definitely be back.

    https://www.cylex.us.com/company/signature-window-washing-28558292.html

    April 9, 2021 at 10:08 | Report abuse | Reply
  21. FbshEncox

    https://thesisacloud.com/ – thesisacloud.com master thesis writing service thesisacloud.com thesis paper writing

    April 9, 2021 at 10:33 | Report abuse | Reply
  22. Best Window Washing Service Near Me Five Points, Denver, CO

    carry on, dont stop

    https://www.elocal.com/profile/signature-window-washing-20438183

    April 9, 2021 at 10:39 | Report abuse | Reply
  23. Best Window Washing Service Near Me Park Hill, Denver, CO

    such a great information for blogger i am a professional blogger thanks

    https://ezlocal.com/co/denver/window-cleaning-service/0916246364

    April 9, 2021 at 11:11 | Report abuse | Reply
  24. Window Washing Service Baker, Denver, CO

    This blog is great check it out

    https://www.localdatabase.com/l/signature-window-washing-denver

    April 9, 2021 at 14:30 | Report abuse | Reply
  25. Window Washing Service Globeville

    Commenting on a blog is an art. Good comments create relations. You're doing great work. Keep it up.

    https://www.mapquest.com/places/signature-window-washing-denver-co-425237348

    April 10, 2021 at 02:01 | Report abuse | Reply
  26. Best Window Cleaning Service Near Me Platt Park, Denver, CO

    this is very informative and intersting for those who are interested in blogging field.

    https://www.merchantcircle.com/signature-window-washing2-denver-co

    April 10, 2021 at 02:38 | Report abuse | Reply
  27. Best Window Washing Service Near Me Lincoln Park, Denver, CO

    I really like this post

    https://www.showmelocal.com/profile.aspx?bid=23190647

    April 10, 2021 at 03:06 | Report abuse | Reply
  28. Best Window Washing Service Near Me Park Hill, Denver, CO

    such a great information for blogger i am a professional blogger thanks

    https://uscity.net/listing/signature_window_washing-9948834

    April 10, 2021 at 04:02 | Report abuse | Reply
  29. Best Window Cleaning Service Near Me Belcaro, Denver, CO

    Your writing style has been surprised me. Thank you, quite great article.

    https://www.brownbook.net/business/49319385/signature-window-washing

    April 10, 2021 at 05:26 | Report abuse | Reply
  30. Best Window Cleaning Service Near Me Platt Park, Denver, CO

    This is a very interesting article. Please, share more like this!

    https://www.dexknows.com/denver-co/bp/signature-window-washing-550947371

    April 10, 2021 at 06:47 | Report abuse | Reply
  31. Best Window Washing Service Near Me Globeville

    Fairly high-quality explanation. continue the good work

    https://www.igotbiz.com/directory/listingdisplay.aspx?lid=59570

    April 10, 2021 at 08:21 | Report abuse | Reply
  32. Window Washing Service Capitol Hill, Denver, CO

    thanks for sharing!

    https://www.manta.com/c/mkkd5lp/signature-window-washing

    April 10, 2021 at 09:25 | Report abuse | Reply
  33. Window Washing Service City Park, Denver, CO

    Great article. Couldn't be write much better! Keep it up!

    http://www.myhuckleberry.com/business-listing.aspx?id=26055965

    April 10, 2021 at 10:05 | Report abuse | Reply
  34. Raje Podatkowe

    Good job here. I truly enjoyed what you had to say. Keep heading because you undoubtedly bring a new voice to this subject. Not many people would say what youve said and still make it interesting. Well, at least Im interested. Cant wait to see additional of this from you.

    http://www.taxes.xmc.pl

    April 10, 2021 at 20:00 | Report abuse | Reply
  35. Rodzaje Podatków Lokalnych

    Are all of those articles written you or did you hire a ghost writer?

    http://www.taxes.xmc.pl

    April 10, 2021 at 21:36 | Report abuse | Reply
  36. Besony

    community college league of california community action agency number , Ivermectin medication [url=http://search.bt.com/result?p=ivermectinsale.me&poi&rd=r2&y=Web%2BSearch#ivermectin-sale]pills ivermectin[/url] community biology partners. community action new lexington ohio positive ana but no antibodies . social organization definition, communityamerica email community first credit union ballard community definition merriam webster [url=http://vipcashforall.com/christian-service-review-2021-56/]community bridges casa grande az US[/url] fa16ee2 , individual-level hyphen, climax community ocr biology .

    April 11, 2021 at 04:32 | Report abuse | Reply
  37. Besony

    community action council dakota county community aid donation hours , pills ivermectin Ivermectin 3 mg sale friends drawing. positive adjectives to describe your co-workers community action lexington kentucky . positive grid spark review, community bridges on mesa drive positive x positive equals individual level natural selection positive adjectives beginning with e spain 0b98438 , social zeitgeber theory, community bridges baseline .

    April 11, 2021 at 05:16 | Report abuse | Reply
  38. Besony

    community bank of america near me positive quotes for women , Ivermectin medication Ivermectin 3 mg sale community acquired pneumonia management. friends nyc community bank na near me . process planning using genetic algorithms, community action greenfield ma community health center danbury ct community college maryland community blood center blue springs usa d0_6698 , community action russellville ky, friends don't lie .

    April 11, 2021 at 05:31 | Report abuse | Reply
  39. tadalafil 40 mg daily

    tadalis sx https://elitadalafill.com/ buy tadalafil us

    April 11, 2021 at 20:21 | Report abuse | Reply
  40. tadalafil pills

    tadalafil generic https://elitadalafill.com/ generic tadalafil 40 mg

    April 12, 2021 at 09:54 | Report abuse | Reply
  41. Add Link

    Your home is valueble for me. Thanks!?This website is mostly a stroll-via for the entire info you wanted about this and didn’t know who to ask. Glimpse here, and you’ll undoubtedly discover it.

    http://www.links.m106.com

    April 12, 2021 at 17:10 | Report abuse | Reply
  42. sildenafil order

    sildenafil 20 https://eunicesildenafilcitrate.com/ cheap sildenafil pills

    April 13, 2021 at 13:57 | Report abuse | Reply
  43. Pianino.XMC.pl

    I just like the helpful information you supply to your articles. I will bookmark your blog and check once more here frequently. I’m moderately sure I’ll be told plenty of new stuff right right here! Good luck for the following!

    http://www.pianino.xmc.pl

    April 13, 2021 at 20:58 | Report abuse | Reply
  44. self life of vardenafil

    vardenafil 40 mg generic https://vegavardenafil.com/ vardenafil buy

    April 14, 2021 at 06:01 | Report abuse | Reply
  45. zithromax canada

    zithromax used to treat https://zithromaxes.com/ azithromycin 500mg chlamydia side effects

    April 14, 2021 at 07:29 | Report abuse | Reply
  46. how much is zithromax

    zithromax pills https://zithromaxes.com/ uti zithromax

    April 14, 2021 at 15:28 | Report abuse | Reply
  47. levitra (vardenafil)

    vardenafil sublingual generic https://vegavardenafil.com/ buy vardenafil over the counter with no pres. online

    April 14, 2021 at 17:21 | Report abuse | Reply
1 2 3 4 5 6 7 8 9 10 11

Leave a Reply to Nardil Champion


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.